[Anti-arrhythmic therapy and cardiac failure]

Area of Science:

• Cardiology
• Electrophysiology
• Pharmacology

Background:

• Cardiac failure frequently presents with complex ventricular and atrial arrhythmias.
• Sudden cardiac death, often unrelated to arrhythmias, accounts for a significant portion of fatalities in heart failure.
• Cardiac structural, metabolic, neuro-hormonal changes, and drug therapies contribute to arrhythmia development.

Purpose of the Study:

• To review the detection and management of arrhythmias in patients with cardiac failure.
• To discuss therapeutic strategies for both paucisymptomatic and symptomatic arrhythmias.
• To highlight the limitations of current antiarrhythmics and the need for novel agents.

Main Methods:

• Utilized continuous ambulatory electrocardiographic recording (Holter system) for arrhythmia detection.
• Analyzed management approaches for arrhythmias based on functional capacity and symptom severity.
• Reviewed the efficacy and limitations of various antiarrhythmic drug classes and implantable defibrillators.

Main Results:

• Holter monitoring identifies 60-80% of complex ventricular and 15-40% of atrial arrhythmias.
• Class I antiarrhythmics and d-sotalol are generally not recommended for paucisymptomatic arrhythmias; beta-blockers require caution.
• For symptomatic arrhythmias, class I agents are insufficient; beta-blockers and amiodarone show promise but require comparison with defibrillators.

Conclusions:

• Current antiarrhythmic therapies have limitations in managing cardiac failure-associated arrhythmias.
• New antiarrhythmic drugs targeting non-selective ion channels, potentially activated by myocardial stretch, are needed.
• Future research should focus on comparing amiodarone and beta-blockers with implantable defibrillators for preventing sudden death.